Do occupational therapy and/or physiotherapy interventions improve activity and participation function for children and adolescents with functional neurological disorder? A systematic review

Abstract

Background/Aims Functional neurological disorder is increasingly common in paediatric neurological practice, yet the role and scope for occupational therapy and physiotherapy intervention remains unclear. The aim of this systematic review was to evaluate if occupational therapy and/or physiotherapy interventions improve activity and participation for children and adolescents with functional neurological disorder compared to usual care. Methods CINAHL, Embase and Medline were searched until May 2023. Eligibility criteria were applied by two reviewers independently. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Data were synthesised narratively and the certainty of evidence assessed using a Grading of Recommendations, Assessment, Development and Evaluation approach. Results A total of eight non-randomised studies (n=451 participants, mean age 13.2 years) were selected. There was very low certainty evidence that for approximately three in four participants, inpatient or outpatient multidisciplinary programmes involving physiotherapy and/or occupational therapy led to recovery at the end of the programme, with recovery and school attendance retained at 12 months. Two studies provided very low certainty evidence that two in three participants attending multidisciplinary programmes were independent on all Pediatric Functional Independence Measure items at programme discharge. Conclusions: There is insufficient evidence to suggest routine occupational therapy and/or physiotherapy interventions improve activity and participation function for children and adolescents with functional neurological disorder compared to usual care. Implications for practice The implications for clinical practice for allied health professionals are ambiguous because of the low-quality of the available evidence. Until further research is conducted to support clinical practice, clinicians must rely on the combination of their clinical expertise and the best available evidence to guide practice.